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Dütsch M, Helbig H, Gamulescu MA, Barth T. [Long-term outcome of macular neovascularization secondary to choroidal osteoma with and without intravitreal anti-VEGF(vascular endothelial growth factor)- treatment]. DIE OPHTHALMOLOGIE 2023; 120:1258-1266. [PMID: 37661239 DOI: 10.1007/s00347-023-01912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/18/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Choroidal osteoma (CO) is a benign ossifying ocular tumor, which is unilateral in most cases. The CO may cause severe visual impairment, especially in the case of a secondary macular neovascularization (MNV). OBJECTIVE Based on a case series of patients with MNV secondary to CO, the variability of the clinical course with and without intravitreal anti-vascular endothelial growth factor (VEGF) treatment is presented. METHODS All patients diagnosed with secondary MNV due to CO between 2007 and 2023 were retrospectively assessed with respect to the clinical course. RESULTS In this study 7 eyes of 5 patients (4 women, 1 man) were diagnosed with secondary MNV due to CO. Intravitreal anti-VEGF treatment was carried out in 2 patients with unilateral MNV and 1 patient was treated in both eyes for bilateral MNV. In another case with bilateral MNV, only 1 eye was treated because of fibrosis in the other eye. A further case with unilateral CO and MNV scars at the initial diagnosis was left untreated. Overall, in 3 out of 5 eyes treated with intravitreal VEGF inhibition stabilization or improvement of visual acuity could be achieved. CONCLUSION In our case series intravitreal anti-VEGF treatment attained a functional stabilization or improvement in 3 out of 5 treated eyes. In one case of CO-associated MNV fibrosis rapidly developed without treatment. Therefore, the clarification for patients with CO about the lifelong risk for development of a secondary MNV is essential in individual cases for early treatment. As no standardized treatment scheme for intravitreal VEGF antibodies for CO-related MNV exists, the treatment is planned on an individual basis.
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Affiliation(s)
- M Dütsch
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - H Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - M-A Gamulescu
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - T Barth
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
- Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
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Zhang L, Ran QB, Lei CY, Zhang MX. Clinical features and therapeutic management of choroidal osteoma: A systematic review. Surv Ophthalmol 2023; 68:1084-1092. [PMID: 37321477 DOI: 10.1016/j.survophthal.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
Choroidal osteoma is a benign ossifying tumor within the choroid. Complications associated with choroidal osteoma, including disruption of retinal pigment epithelium, atrophy of photoreceptors, subretinal fluid, and choroidal neovascularization, present challenges for clinicians, and management remain controversial. We performed a comprehensive search in the PubMed, EMBASE, and Ovid databases for published studies and case reports relating to the management of choroidal osteoma. Since it was first described in 1978, various case reports of ocular complications associated with choroidal osteoma have been documented, and various therapies have yielded different outcomes. We systematically evaluate the literature published on this rare entity.
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Affiliation(s)
- Li Zhang
- Sichuan University West China Hospital, Chengdu, China.
| | - Qi-Bo Ran
- Sichuan University West China Hospital, Chengdu, China.
| | - Chun-Yan Lei
- Sichuan University West China Hospital, Chengdu, China.
| | - Mei-Xia Zhang
- Sichuan University West China Hospital, Chengdu, China.
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Goel S, Das S, Rijey AJ, Das D. Multimodal imaging in choroidal osteomas. GMS OPHTHALMOLOGY CASES 2022; 12:Doc07. [PMID: 35291583 PMCID: PMC8900201 DOI: 10.3205/oc000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Choroidal osteoma is a rare benign tumor which is found in the posterior pole of the eye. We herein describe multimodal imaging in two cases of choroidal osteoma. Fundus of our first case showed a yellowish-orange colored subretinal lesion at the posterior pole. Multicolor imaging highlighted the lesion with greenish hue. Infrared reflectance showed hyporeflectance. A dense echogenic plaque persisting in lower gain was noted on B-scan. FFA showed hyperfluorescence with corresponding hypocyanescence on ICG. EDI OCT showed an increase in choroidal thickness with elevated retinal pigment epithelium. The second case showed choroidal osteoma with active choroidal neovascular membrane that responded to intravitreal injection of Ranibizumab.
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Affiliation(s)
- Sugandha Goel
- Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Sudipta Das
- Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India,*To whom correspondence should be addressed: Sudipta Das, Aditya Birla Sankara Nethralaya, 147 Mukundapur, E. M. Bypass, Kolkata 700099, West Bengal, India, E-mail:
| | - A. Joash Rijey
- Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Debmalya Das
- Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
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Zhang Y, Fang J, Zhao S, She X, Wang J, Shen L. Secondary choroidal neovascularization due to choroidal osteoma after 9 years follow-up. BMC Ophthalmol 2021; 21:242. [PMID: 34058993 PMCID: PMC8167975 DOI: 10.1186/s12886-021-02004-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Choroidal osteoma is a benign intraocular tumor that can increase risk of developing choroidal neovascularization. The visual prognosis is influenced by the tumor location, decalcification status, overlying RPE atrophy, presence of choroidal neovascularization, persistence of subretinal fluid and occurrence of subretinal hemorrhages. CASE PRESENTATION The authors present a 40-year-old woman diagnosed with choroidal osteoma of the right eye. Her best corrected visual acuity was 12/20 but decreased to 5/20 due to secondary choroidal neovascularization after 8 years follow up. Fundus examination revealed an enlarged choroidal osteoma in most margins at posterior pole with schistose hemorrhage beside macula. Optical coherence tomography angiography revealed unique features in the vascular changes of choroidal neovascularization in choroidal osteoma in the outer retinal layer and choroid capillary layers, and subretinal neovascularization. Indocyanine green fluorescence angiography showed there was hypo-fluorescence at the peripapillary with faint hyper-fluorescence at the macular, corresponding to the location on the fundus photograph. The patient received 3 injections of intravitreal ranibizumab. After 1 year follow up, her visual acuity of the right eye was 18/20 and the CNV had regressed. CONCLUSIONS We present the findings and treatment of a case of choroidal osteoma with secondary choroidal neovascularization. Optical coherence tomography angiography combined with FFA and ICGA is used to analysis the characteristics of secondary choroidal neovascularization. Optical coherence tomography angiography can reveal some unique characteristics in the vascular changes compared to fundus fluorescein angiography.
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Affiliation(s)
- Yun Zhang
- Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Jia Fang
- Yongkang First People's Hospital of Hangzhou Medical College, Jinhua, Zhejiang, China
| | - Shixin Zhao
- Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Xiangjun She
- Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Jun Wang
- Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Lijun Shen
- Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.
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Kim D, Ryu G, Sagong M. Polypoidal choroidal vasculopathy as a complication of choroidal osteoma: A case report. Medicine (Baltimore) 2020; 99:e19927. [PMID: 32443292 PMCID: PMC7253871 DOI: 10.1097/md.0000000000019927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Choroidal osteoma (CO) is a rare benign tumor that particularly affects young, healthy women. Its prognosis is influenced by complications, such as choroidal neovascularization (CNV), subretinal hemorrhage, subretinal fluid (SF), decalcification status, and overlying retinal pigment epithelium (RPE) atrophy. In case of CNV as the complication of CO, it is typically present in the classic form; however, reports on polypoidal choroidal vasculopathy (PCV) have been rare. Here, we report a case of an older, male patient with PCV as a complication of CO. PATIENT CONCERNS A 70-year-old male patient visited the hospital with vision impairment in the right eye since 2 weeks. DIAGNOSIS Fundus examination revealed a red-yellow, well-demarcated, scalloped lesion around the optic nerve in each eye; the lesions were highly reflective on ultrasound examination, and thus, CO was diagnosed. Indocyanine green fluorescence angiography and optical coherence tomography (OCT) revealed that the right eye also had PCV accompanied with SF. OCT confirmed the presence of large quiescent type 1 CNV bilaterally in decalcified areas of the lesions adjacent to the optic nerve. INTERVENTIONS Intravitreal bevacizumab (IB) injection was performed. OUTCOMES Best-corrected visual acuity had improved and OCT showed a decrease in the SF, while OCT angiography showed partial regression of branching vascular network. CONCLUSION CO can be accompanied by quiescent type 1 CNV; this should be closely monitored because it can progress to PCV. Optical coherence tomography, alongside indocyanine green fluorescence angiography, is useful for the diagnosis and monitoring of potential CNV as a complication of CO.
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Grzybowski A, Kanclerz P. The Role of Steroids and NSAIDs in Prevention and Treatment of Postsurgical Cystoid Macular Edema. Curr Pharm Des 2019; 24:4896-4902. [PMID: 30727876 DOI: 10.2174/1381612825666190206104524] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/24/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pseudophakic cystoid macular edema (PCME) remains one of the most common visionthreatening complication of phacoemulsification cataract surgery (PCS). Pharmacological therapy is the current mainstay of both prophylaxis, and treatment of PCME in patients undergoing PCS. We aimed to review pharmacological treatment options for PCME, which primarily include topical steroids, topical nonsteroidal antiinflammatory drugs (NSAIDS), periocular and intravitreal steroids, as well as anti-vascular endothelial growth factor therapy. METHODS The PubMed and Web Of Science web platforms were used to find relevant studies using the following keywords: cataract surgery, phacoemulsification, cystoid macular edema, and pseudophakic cystoid macular edema. Of articles retrieved by this method, all publications in English and abstracts of non-English publications were reviewed. Other studies were also considered as a potential source of information when referenced in relevant articles. The search revealed 193 publications. Finally 82 articles dated from 1974 to 2018 were assessed as significant and analyzed. RESULTS Based on the current literature, we found that corticosteroids remain the mainstay of PCME prophylaxis in uncomplicated cataract surgery, while it is still unclear if NSAID can offer additional benefits. In patients at risk for PCME development, periocular subconjunctival injection of triamcinolone acetonide may prevent PCME development. For PCME treatment the authors recommend a stepwise therapy: initial topical steroids and adjuvant NSAIDs, followed by additional posterior sub-Tenon or retrobulbar corticosteroids in moderate PCME, and intravitreal corticosteroids in recalcitrant PCME. Intravitreal anti-vascular endothelial growth factor agents may be considered in patients unresponsive to steroid therapy at risk of elevated intraocular pressure, and with comorbid macular disease. CONCLUSION Therapy with topical corticosteroids and NSAIDs is the mainstay of PCME prophylaxis and treatment, however, periocular and intravitreal steroids should be considered in refractory cases.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
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Narayanan R, Shah V. Intravitreal Bevacizumab in the Management of Choroidal Neovascular Membrane Secondary to Choroidal Osteoma. Eur J Ophthalmol 2018; 18:466-8. [DOI: 10.1177/112067210801800327] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - V.A. Shah
- Departement of Ophthalmology, University of Missouri Kansas City School of Medicine, Kansas City, MO - USA
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Sarıgül Sezenöz A, Akça Bayar S, Yılmaz G. Choroidal Osteoma and Secondary Choroidal Neovascularization Treated with Ranibizumab. Turk J Ophthalmol 2017; 47:243-246. [PMID: 28845332 PMCID: PMC5563556 DOI: 10.4274/tjo.86658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/09/2016] [Indexed: 12/01/2022] Open
Abstract
A 47-year-old female patient presented with a complaint of decreased vision in the right eye. Her visual acuity was 0.16 in the right eye and 1.0 in the left eye. Fundus examination revealed a slightly elevated, yellowish-white lesion with regular borders at the macula of the right eye. Early and late hyperfluorescence related with choroidal neovascularization (CNV) was detected in the right eye on fundus fluorescein angiography. B-scan ultrasonography revealed a hyperechoic choroidal lesion with acoustic shadowing. The lesion was diagnosed as choroidal osteoma. The patient received 3 injections of intravitreal ranibizumab. After 4 months, the visual acuity of the right eye was 0.9 and the CNV had regressed. Follow-up at about 7 months revealed reduced visual acuity in the right eye with an increase in subretinal fluid. An additional ranibizumab injection was administered. In this case report, we discuss the findings and treatment of a rare case of choroidal osteoma with secondary CNV.
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Affiliation(s)
| | - Sezin Akça Bayar
- Başkent University Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Gürsel Yılmaz
- Başkent University Hospital, Ophthalmology Clinic, Ankara, Turkey
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9
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Intravitreal bevacizumab monotherapy for choroidal neovascularisation secondary to choroidal osteoma. Eye (Lond) 2016; 30:843-9. [PMID: 27034203 DOI: 10.1038/eye.2016.50] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 01/19/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeThe purpose of this study is to present the outcomes of a series of patients with choroidal neovascular membrane (choroidal neovascularisation (CNV)) secondary to a choroidal osteoma undergoing anti-VEGF monotherapy.Patients and methodsRetrospective series of patients with choroidal neovascularization secondary to choroidal osteoma. All patients underwent clinical and imaging assessment (fundus photo, B-scan ultrasonography, fluorescein angiography, and optical coherence tomography-where available), and were managed with intravitreal anti-VEGF injections (Bevacizumab). Visual acuity and central retinal thickness were recorded pre treatment and at the end of the follow-up period.ResultsEight patients were included in this study. Of this, 6/8 had predominantly classic or classic and 2/8 patients had minimally classic or occult CNV. Each patient received 3-10 injections of bevacizumab. Median follow-up was 9 months (3-15 months). Visual acuity improved in 5 patients, by 2-6 Snellen lines. CNV completely regressed in 5 cases and partially regressed in 3 cases. Mean CRT reduction was 122 μm (6 to -230 μm).ConclusionIntravitreal bevacizumab can be an effective treatment modality in the management of vision threatening CNV secondary to choroidal osteoma.
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10
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Yoshikawa T, Takahashi K. Long-term outcomes of intravitreal injection of bevacizumab for choroidal neovascularization associated with choroidal osteoma. Clin Ophthalmol 2015; 9:429-37. [PMID: 25784788 PMCID: PMC4356687 DOI: 10.2147/opth.s78817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the outcomes of intravitreal injections of bevacizumab for choroidal neovascularization (CNV) associated with choroidal osteoma. Methods Retrospective consecutive case series. Three eyes of three patients were studied. All patients were treated with intravitreal injections of bevacizumab for CNV associated with choroidal osteoma. Best-corrected visual acuity, central foveal thickness, tumor thickness on spectral domain optical coherence tomography, and subretinal pigmentation around the CNV were evaluated. Results The mean number of intravitreal injections of bevacizumab was 2.0 (range 1–3). The mean follow-up time was 56.0 months (range 25–99 months). The mean LogMAR visual acuity worsened from 0.1 to 0.6. LogMAR visual acuity loss of 0.7 or worse occurred in two of three eyes. CNV was located in the subfoveal area in two eyes, and CNV was located in the juxtafoveal area in one eye. The mean central foveal thickness decreased from 407 μm to 251 μm. The mean tumor thickness decreased from 709 μm to 608 μm. All eyes had subretinal pigmentation around the CNV. Conclusion Intravitreal injections of bevacizumab for subfoveal CNV associated with decalcified choroidal osteoma resulted in poor visual acuity.
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Affiliation(s)
| | - Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, Osaka, Japan
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11
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Abstract
Choroidal osteomas are rare benign ossifying tumors that appear as irregular slightly elevated, yellow-white, juxtapapillary, choroidal mass with well-defined geographic borders, depigmentation of the overlying pigment epithelium; and with multiple small vascular networks on the tumor surface. Visual loss results from three mechanisms: Atrophy of the retinal pigment epithelium overlying a decalcified osteoma; serous retinal detachment over the osteoma from decompensated retinal pigment epithelium, and most commonly from choroidal neovascularization. Recent evidence points to the beneficial effects of intravitreal vascular endothelial growth factor antagonists in improving visual acuity in serous retinal detachment with or without choroidal neovascularization.
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Affiliation(s)
- Ramzi M Alameddine
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Eman Kahtani
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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OUTCOMES OF ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN THE MANAGEMENT OF CHOROIDAL NEOVASCULARIZATION ASSOCIATED WITH CHOROIDAL OSTEOMA. Retina 2014; 34:1750-6. [DOI: 10.1097/iae.0000000000000187] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Role of Intravitreal Antivascular Endothelial Growth Factor Injections for Choroidal Neovascularization due to Choroidal Osteoma. J Ophthalmol 2014; 2014:210458. [PMID: 25147732 PMCID: PMC4132478 DOI: 10.1155/2014/210458] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 07/05/2014] [Indexed: 11/17/2022] Open
Abstract
We treated 26 eyes of 25 young patients having a mean age of 30 years with intravitreal vascular endothelial growth factor (VEGF) inhibitor for choroidal new vessel (CNV) formation overlying choroidal osteoma over a mean follow-up of 26 months. Mean number of injections was 2.4 at 6 months, 3.2 at 12 months, and 5.5 at 24 months. CNV was subfoveal in 14 eyes, juxtafoveal in 5, extrafoveal in 5, and peripapillary in 2. By paired comparison, mean decrease from baseline was 119.7 microns at 6 months (n = 15; P = 0.001), 105.3 microns at 1 year (n = 10; P = 0.03), and 157.6 microns at 2 years (n = 7; P = 0.08). BCVA improved by 3.3 lines at 6 months after therapy (n = 26; P < 0.001), 2.8 lines (n = 20; P = 0.01) at 1 year, and 3.1 lines (n = 13; P = 0.049) at 2 years. We conclude that intravitreal anti-VEGF injections improve vision in majority of eyes with CNV from choroidal osteoma.
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Erol MK, Coban DT, Ceran BB, Bulut M. Retinal pigment epithelium tear formation following intravitreal ranibizumab injection in choroidal neovascularization secondary to choroidal osteoma. Cutan Ocul Toxicol 2014; 33:259-63. [PMID: 24517498 DOI: 10.3109/15569527.2013.844702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Choroidal osteoma is an extremely rare osseous tumor of the choroid where choroidal neovascularization (CNV) is the major cause of visual loss. We report the case of a 28-year-old female with CNV secondary to choroidal osteoma, who developed RPE tear after intravitreal ranibizumab treatment.
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Affiliation(s)
- Muhammet K Erol
- Department of Ophthalmology, Antalya Training and Research Hospital , Antalya , Turkey , and
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Mercé E, Korobelnik JF, Delyfer MN, Rougier MB. [Intravitreal injection of bevacizumab for CNV secondary to choroidal osteoma and follow-up by Spectral-Domain OCT]. J Fr Ophtalmol 2012; 35:508-13. [PMID: 22695057 DOI: 10.1016/j.jfo.2011.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 10/23/2011] [Accepted: 11/04/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Choroidal osteoma is a rare, ossifying tumor, which, while benign, may be complicated by choroidal neovascularization. METHODS An 11-year-old boy presented with blurred vision in the right eye for few days. Fundus examination showed bulky lesion in the posterior pole containing a sub-retinal hemorrhage. The geographic borders and color of the mass were typical of choroidal osteoma despite the unusual macular location. The diagnosis was confirmed by ultrasonography. The patient was treated with three successive intravitreal injections of 1.25 mg/0.05 mL bevacizumab (IVB) under general anesthesia, due to recurrences of neovascular activity. SD-OCT in EDI mode was carried out prior to each injection. RESULTS SD-OCT before and after each bevacizumab injection confirmed regression of serous retinal detachment (SRD) at various locations throughout the lesion, especially in the hemorrhagic zone. It also allowed us to differentiate the active decalcified zones from the inactive calcified zones and to follow treatment response. DISCUSSION The treatment of choroidal neovascularization (CNV) secondary to choroidal osteoma is not well defined. As for other etiologies of CNV, anti-VEGF agents (such as bevacizumab) appear to be effective in regressing CNV and improving visual function. In our young patient, general anesthesia was necessary to administer each injection. SD-OCT allows diagnostic confirmation and follow-up of treatment. EDI mode is helpful in studying the choroid and the osteoma. CONCLUSION We report a rare case of macular choroidal osteoma, examined by SD-OCT. CNV required several anti-VEGF injections, with good anatomical and functional results.
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Affiliation(s)
- E Mercé
- Service d'Ophtalmologie, CHU Dupuytren, 4, avenue Martin-Luther-King, 87042 Limoges, France.
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Kubota-Taniai M, Oshitari T, Handa M, Baba T, Yotsukura J, Yamamoto S. Long-term success of intravitreal bevacizumab for choroidal neovascularization associated with choroidal osteoma. Clin Ophthalmol 2011; 5:1051-5. [PMID: 21845033 PMCID: PMC3151569 DOI: 10.2147/opth.s22219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe a case of choroidal osteoma with choroidal neovascularization (CNV) that was successfully treated with two intravitreal injections of bevacizumab (IVB). DESIGN AND METHODS Case report on a 12-year-old Japanese girl who presented with a sudden decrease in vision in her left eye. At the first visit, 2 days after the onset of her symptoms, her visual acuity (VA) in her left eye was 0.2. Ophthalmoscopy showed a hemorrhage of 5 disc diameters under the retinal pigment epithelium and a serous retinal detachment at the posterior pole of the left eye. These findings were confirmed by optical coherence tomography. Fluorescein angiography (FA) and indocyanine green angiography (ICGA) showed several points of leakage around the fovea, which suggested a CNV. From these findings, the patient was diagnosed with choroidal osteoma with a CNV. The submacular hemorrhage was from the CNV associated with the choroidal osteoma. We treated her with two injections of 1.25 mg/0.05 mL IVB with a 4-month interval. RESULTS The patient's VA in her left eye improved to 0.7, and this vision was maintained for 4 years. The CNV disappeared in the FA and ICGA images and no recurrence was observed after 4 years. CONCLUSION Our findings indicate that IVB is effective in resolving CNV in eyes with an osteoma and prevents a decrease of vision in eyes with a choroidal osteoma with a CNV.
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Affiliation(s)
- Mariko Kubota-Taniai
- Department of Ophthalmology, National Hospital Organization, Chiba Medical Center, Chiba, Japan
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INTRAVITREAL BEVACIZUMAB IN THE MANAGEMENT OF SUBRETINAL FLUID ASSOCIATED WITH CHOROIDAL OSTEOMA. Retina 2010; 30:945-51. [DOI: 10.1097/iae.0b013e3181c720ca] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rao S, Gentile RC. Successful treatment of choroidal neovascularization complicating a choroidal osteoma with intravitreal bevacizumab. Retin Cases Brief Rep 2010; 4:303-305. [PMID: 25390904 DOI: 10.1097/icb.0b013e3181aff523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report the effect of off-label use of bevacizumab (Avastin) in the treatment of choroidal neovascularization associated with a choroidal osteoma. METHODS Interventional case report examining antivascular endothelial growth factor therapy used for choroidal neovascularization complicating a choroidal osteoma. RESULTS A 24-year-old man with a choroidal osteoma presented with metamorphopsia and decreased vision in his left eye of 20/60. Clinical examination, fluorescein angiography, B-scan ultrasonography, and optical coherence tomography revealed a well-circumscribed macular choroidal osteoma with overlying subretinal hemorrhage and a choroidal neovascular membrane. The patient was treated with a series of 3 intravitreal bevacizumab (Avastin) injections (1.25 mg/0.05 mL) performed at baseline, 1 month, and 2 months. Treatment resulted in resolution of subretinal hemorrhage and fluid with improvement in visual acuity to 20/30 at the 5-month follow-up. CONCLUSION Intravitreal bevacizumab seems to be a promising treatment for choroidal neovascularization (CNV) associated with choroidal osteomas.
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Affiliation(s)
- Sunil Rao
- From the *Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, New York; and †Department of Ophthalmology, New York Medical College, Valhalla, New York
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Song MH, Roh YJ. Intravitreal ranibizumab in a patient with choroidal neovascularization secondary to choroidal osteoma. Eye (Lond) 2008; 23:1745-6. [PMID: 18949006 DOI: 10.1038/eye.2008.313] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Ahmadieh H, Vafi N. Dramatic response of choroidal neovascularization associated with choroidal osteoma to the intravitreal injection of bevacizumab (Avastin). Graefes Arch Clin Exp Ophthalmol 2007; 245:1731-3. [PMID: 17653753 DOI: 10.1007/s00417-007-0636-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 04/28/2007] [Accepted: 05/07/2007] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To report the dramatic response of juxtafoveal choroidal neovascularization (CNV) associated with choroidal osteoma to a single intravitreal injection of bevacizumab. METHODS A 19-year-old female presented with decreased visual acuity and metamorphopsia in her right eye. Best corrected visual acuity assessment, ophthalmic examination, fundus photography, fluorescein angiography, optical coherence tomography (OCT), and high-resolution computed tomography (CT) scan of the orbit was performed. A diagnosis of classic juxtafoveal CNV associated with choroidal osteoma was made. Intravitreal injection of 1.25 mg of bevacizumab was performed. RESULTS Visual acuity of the right eye was 20/200 before treatment. Visual improvement to 20/25 and the resolution of metamorphopsia was noticed six weeks after the intravitreal injection of bevacizumab. Regression of the CNV was confirmed according to ophthalmoscopic, fluorescein angiographic, and OCT findings. The treatment effect persisted during a 9-month follow-up period. CONCLUSION The intravitreal injection of bevacizumab can result in the rapid regression of CNV secondary to choroidal osteoma.
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Affiliation(s)
- Hamid Ahmadieh
- Ophthalmic Research Center, Labbafinejad Medical Center, Shaheed Beheshti Medical University, Tehran, Iran.
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